Acute calcific tendinitis of the longus colli: an imaging diagnosis

Acute calcific retropharyngeal tendinitis or longus colli tendinitis is an uncommon benign condition presenting as acute neck pain. Clinically, it can be misdiagnosed as retropharyngeal abscess, traumatic injury, or infectious spondylitis. The diagnosis is made radiographically by calcification anterior to C1-C2 and prevertebral soft-tissue swelling. We present two cases of this uncommon condition to illustrate the classic findings on CT and MRI. In addition to the typical calcifications anterior to C1-C2, we detected a retropharyngeal effusion in both patients and effusions involving both lateral atlantoaxial joints in one patient, which to our knowledge has not been published in the literature. In both patients, the correct diagnosis was established by prospective review of the radiographic studies. Recognition of the pathognomonic imaging appearance allows for easy diagnosis preventing unnecessary tests and treatment.